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Changes in Error Patterns during N-back Training Indicate Reliance on Subvocal Rehearsal

Chooi WT, Logie R

Mem Cognit, 2020 11;48(8):1484-1503.
PMID: 32661910 DOI: 10.3758/s13421-020-01066-w

Contemporary cognitive training literature suggests that training on an adaptive task produces improvements only in the trained task or near transfer effects. No study has yet systematically explained the mechanism behind improved performance on the N-back. In this study, we first investigated how improvements in an N-back task using eight pairs of phonologically similar words as stimuli occurred by examining error distributions of the task over training sessions. Nineteen participants (non-native English speakers) trained for 20 sessions over 5 weeks. We observed a reduction in false alarms to non-target words and fewer missed target words. Though the absolute number of phonological-based errors reduced as training progressed, the proportion of this error type did not decrease over time suggesting participants increasingly relied on subvocal rehearsal in completing the N-back. In the second experiment, we evaluated if improvements developed during N-back training transferred to tasks that relied on serial order memory using simple span tasks (letter span with phonologically distinct letters, letter span with phonologically similar letters, digit span forward, and digit span backward). Twenty-nine participants trained on the N-back and 16 trained on the Operation Span (OSPAN) for 15 sessions over 4 weeks. Neither group of participants showed improvements on any of the simple span tasks. In the third experiment, 20 participants (16 native English speakers) trained on the N-back for 15 sessions over 4 weeks also showed increasing reliance on subvocal rehearsal as they progressed through training. Self-report strategy use did not predict improvements on the N-back.
A systematic review of the effects of positive versus negative framing on cancer treatment decision making

Tang YT, Chooi WT

Psychol Health, 2023;38(9):1148-1173.
PMID: 34856837 DOI: 10.1080/08870446.2021.2006197

OBJECTIVE: Presenting treatment outcomes positively or negatively may differently influence treatment preferences and lead to sub-optimal decision in a medical context. This review systematically organised how positive versus negative framing of treatment outcomes influenced cancer treatment decisions of cancer patients and individuals without a cancer diagnosis.
DESIGN: Three databases (PubMed, PsycInfo and Scopus) were searched for studies reporting the effects of positive versus negative framing on cancer treatment decision-making from 1981 to December 2020.
MAIN OUTCOME MEASURE: The effects of positive versus negative framing on cancer treatment preferences and the elimination of framing effect were evaluated.
RESULTS: A total of 12 studies that met inclusion criteria were reviewed. Framing effect was consistently observed in individuals without a cancer diagnosis. There was not enough evidence to suggest a robust framing effect in cancer patients. Surgery was preferred in positive framing, whereas adjuvant therapy was preferred in negative framing. Justification intervention significantly eliminated framing effect. Mixed framing failed to eliminate framing effect.
CONCLUSION: Current recommendations for presenting treatment options are based on research in cancer-screening decision-making. Knowledge of how positive versus negative framing affect cancer patients' treatment decisions is still limited. Our review highlighted the need for continued research in this area.
Fulltext An evaluation of practices, perceptions and understanding about use of acetaminophen (paracetamol) among malaysian consumers: a qualitative study

Tan SF, Chong CP, Chooi WT

Malaysian Journal of Pharmaceutical Science, 2015;13(1):25-41.
MyJurnal

An assessment on the use of acetaminophen (paracetamol) among consumers would
provide guidance for implementing strategies to overcome the misuse of acetaminophencontaining
products. This study aims to evaluate Malaysian consumers’ practices,
perceptions and understanding regarding the use of acetaminophen. A semi-structured
qualitative study utilising face-to-face interviews was conducted among 14 consumers
aged 24 to 82 years old who live in Pulau Pinang, Malaysia. Transcripts of all the
interviews were generated from audio tapes and were analysed for the issues and themes
emerging from the text; the transcripts were independently coded and verified by experts.
The consumers had a positive attitude towards the popularity, safety and efficacy of
acetaminophen. The consumers predominantly used acetaminophen for pain and fever.
Some consumers tended to increase the frequency and dosage of acetaminophen
consumption if their condition persisted. Consumers had difficulty recognising the generic
acetaminophen-containing products available in the market. Health literacy investigations
have found that consumers have a lack of knowledge regarding the correct dosing
regimen for acetaminophen in adults and children. The consumers were not aware of the
precautions and toxicities of acetaminophen. To increase awareness of acetaminophen
poisoning in Malaysia, the consumers suggested that educational tools regarding the
proper use of acetaminophen are needed from the Ministry of Health and policy-makers.
The information gained from this study emphasises the importance of educational
interventions to educate the public on the proper use of acetaminophen in Malaysia.
Characteristics of Malaysian 16-year-old girls who reported regular binge eating episodes and the associated risk factors: a descriptive study

Tang YT, Liew JX, Chooi WT

Int J Adolesc Med Health, 2023 Oct 01;35(5):411-422.
PMID: 37712612 DOI: 10.1515/ijamh-2023-0064

OBJECTIVES: Adolescents may suffer from binge eating (BE), that refers to consuming a large amount of food in a short period of time and accompanied by feelings of loss of control (LOC) over eating. This study compared the prevalence of BE between 16-year-old Malaysian girls from two types of public schools, Malay-English-medium and Chinese-Malay-English-medium schools. Additionally, this study identified associated risk factors of those who presented regular BE episodes, including LOC eating, anxiety, body mass index (BMI), body dissatisfaction (BD) and eating disorders (EDs) psychopathology.
METHODS: 398 participants completed self-reports assessing BE symptoms, LOC eating, state anxiety, trait anxiety, EDs psychopathology, and BD. They also reported heights and weights. Descriptive statistics, t-tests, chi-square tests, and Z-test for independent proportions were conducted.
RESULTS: There was no significant difference in either the prevalence of BE or EDs psychopathology between participants from the two types of schools. 71 (17.8 %) participants reported moderate-to-severe symptoms of BE, and 46 (11.6 %) reported moderate-to-severe levels of LOC eating. Those who reported moderate-to-severe symptoms of BE reported significantly higher levels of LOC eating, BD, drive to be thinner, BMI, state anxiety, and EDs psychopathology, compared to those who reported none-to-minimal BE.
CONCLUSIONS: BE and LOC eating appeared to be relatively common among secondary school girls in Malaysia. The relatively high prevalence of BE amongst adolescents in our sample highlighted the importance of early identification of signs for BE as preventive measures from developing EDs psychopathology among children and adolescents. We propose that attitudes towards eating and body image-related concerns should be included in school screenings aimed at preventing psychological problems in minors.
Exploration of Hope Among Young Adults with Cancer in Malaysia

Sabri S, Mohamed Hussin NA, Chooi WT

J Adolesc Young Adult Oncol, 2023 Jun 30.
PMID: 37389816 DOI: 10.1089/jayao.2023.0016

Purpose: Hope is vital for cancer patients to cope with their illnesses. It is positively associated with better health outcomes, quality of life, and daily functioning. However, restoring hope after a cancer diagnosis can be challenging, especially for young adult cancer patients. This research aimed to investigate hope among young adults with cancer throughout their cancer experience and the exploration of hope preservation in these individuals. Methods: This qualitative study involved 14 young adults recruited from a closed Facebook group. The median age of the participants was 30.5 years (range 20-39 years), and their median survival year was 3 years (range 1-18 years from the date of diagnosis). Semistructured interviews and a thematic analysis were performed to identify the major themes that emerged from these interviews. Results: The findings identified that young adults expressed hopes for cancer advocacy, good physical and mental health, ease in the afterlife, and uncertain hopes due to thoughts of death. Three areas that influenced their hope are: (1) active hope with cancer peers; (2) cancer prognosis and hope; and (3) hope comes from prayer. Their cultural and religious beliefs influenced the various forms of hope and affected their experiences with cancer. In addition, this study discovered that not all positive communication with their physician resulted in hope. Conclusion: These findings provide important insight to health care professionals (HCPs) by encouraging young adults to discuss hope and improving the existing oncology social work-based intervention. This study suggests that hope is essential for chronic illness patients and should be supported continuously during and after treatments.
Feature extraction and classification for EEG signals using wavelet transform and machine learning techniques

Amin HU, Malik AS, Ahmad RF, Badruddin N, Kamel N, Hussain M, et al.

Australas Phys Eng Sci Med, 2015 Mar;38(1):139-49.
PMID: 25649845 DOI: 10.1007/s13246-015-0333-x

This paper describes a discrete wavelet transform-based feature extraction scheme for the classification of EEG signals. In this scheme, the discrete wavelet transform is applied on EEG signals and the relative wavelet energy is calculated in terms of detailed coefficients and the approximation coefficients of the last decomposition level. The extracted relative wavelet energy features are passed to classifiers for the classification purpose. The EEG dataset employed for the validation of the proposed method consisted of two classes: (1) the EEG signals recorded during the complex cognitive task--Raven's advance progressive metric test and (2) the EEG signals recorded in rest condition--eyes open. The performance of four different classifiers was evaluated with four performance measures, i.e., accuracy, sensitivity, specificity and precision values. The accuracy was achieved above 98 % by the support vector machine, multi-layer perceptron and the K-nearest neighbor classifiers with approximation (A4) and detailed coefficients (D4), which represent the frequency range of 0.53-3.06 and 3.06-6.12 Hz, respectively. The findings of this study demonstrated that the proposed feature extraction approach has the potential to classify the EEG signals recorded during a complex cognitive task by achieving a high accuracy rate.
Fulltext P300 correlates with learning & memory abilities and fluid intelligence

Amin HU, Malik AS, Kamel N, Chooi WT, Hussain M

J Neuroeng Rehabil, 2015;12:87.
PMID: 26400233 DOI: 10.1186/s12984-015-0077-6

Educational psychology research has linked fluid intelligence with learning and memory abilities and neuroimaging studies have specifically associated fluid intelligence with event related potentials (ERPs). The objective of this study is to find the relationship of ERPs with learning and memory recall and predict the memory recall score using P300 (P3) component.
Fulltext COVID-19 Impact on Healthcare and Supportive Services for People Who Use Drugs (PWUDs) in Malaysia

Vicknasingam B, Mohd Salleh NA, Chooi WT, Singh D, Mohd Zaharim N, Kamarulzaman A, et al.

Front Psychiatry, 2021;12:630730.
PMID: 33854449 DOI: 10.3389/fpsyt.2021.630730

Background: Restrictive orders and temporary programmatic or ad hoc changes within healthcare and other supportive systems that were implemented in response to the COVID-19 epidemic in Malaysia may have created hindrances to accessing healthcare and/or receiving other supportive services for people who use drugs (PWUDs). Design: A primarily qualitative study has been conducted to evaluate how service providers and recipients were adapting and coping during the initial periods of the COVID-19 response. Settings: The study engaged several healthcare and non-governmental organizations (NGOs) in the peninsular states of Penang, Kelantan, Selangor, and Melaka. Participants: Medical personnel of methadone maintenance treatment (MMT) programs (n = 2) and HIV clinics (n = 3), staff of NGO services (n = 4), and MMT patients (n = 9) were interviewed using a semi-structured format. Results: Interviewed participants reported significant organizational, programmatic, and treatment protocols related changes implemented within the healthcare and support services in addition to nationally imposed Movement Control Orders (MCOs). Changes aimed to reduce patient flow and concentration at the on-site services locations, including less frequent in-person visits, increased use of telemedicine resources, and greater reliance on telecommunication methods to maintain contacts with patients and clients; changes in medication dispensing protocols, including increased take-home doses and relaxed rules for obtaining them, or delivery of medications to patients' homes or locations near their homes were reported by the majority of study participants. No significant rates of COVID-19 infections among PWUDs, including among those with HIV have been reported at the study sites. Conclusions: Although the reported changes presented new challenges for both services providers and recipients and resulted in some degree of initial disruption, generally, all participants reported successful implementation and high levels of compliance with the newly introduced restrictions, regulations, and protocols, resulting in relatively low rates of treatment disruption or discontinuation at the study sites.
Time sharing in working memory processing

Barrouillet P, Camos V, Minamoto T, Nishiyama S, Chooi WT, Morita A, et al.

J Exp Psychol Learn Mem Cogn, 2023 Oct;49(10):1539-1556.
PMID: 37307321 DOI: 10.1037/xlm0001261

Although working memory (WM) is usually defined as a cognitive system coordinating processing and storage in the short term, in most WM models, memory aspects have been developed more fully than processing systems, and many studies of WM tasks have tended to focus on memory performance. The present study investigated WM functioning without focusing exclusively on short-term memory performance by presenting participants with an n-back task on letters, n varying from 0 to 2, each letter being followed by a tone discrimination task involving from one to three tones. Predictions regarding the reciprocal effects of these tasks on each other were motivated by the time-based resource-sharing (TBRS) theoretical framework for WM that assumes the temporal sharing of attention between processing and memory. Although, as predicted, increasing the n value had a detrimental effect on tone discrimination in terms of accuracy and response times, and increasing the number of tones disrupted speed and accuracy on n-back performance, the overall pattern of results did not perfectly fit the TBRS predictions. Nonetheless, the main alternative models of WM do not seem to offer a complete account. The present findings point toward the need to use a larger range of tasks and situations in designing and testing models of WM. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
Emerging Drug Use Trends in Kelantan, Malaysia

Desrosiers A, Chooi WT, Zaharim NM, Ahmad I, Mohd Yasin MA, Syed Jaapar SZ, et al.

J Psychoactive Drugs, 2016 05 25;48(3):218-26.
PMID: 27224011 DOI: 10.1080/02791072.2016.1185553

The primarily rural and agrarian Kelantan province of Malaysia has high rates of drug use and is characterized by unique sociocultural factors. Combining qualitative and ethnographic methods, we investigated drug use and treatment needs of people who use drugs (PWUD) in rural areas of Kelantan. In February 2014, field visits, participant observation, and focus group discussions (FGDs) with 27 active PWUD were conducted in rural areas surrounding the capital city of Kelantan. The findings indicate a high prevalence of opiate and amphetamine type stimulants (ATS) use in these areas. FGD participants reported initiating drug use at early ages due to peer influences, to relieve boredom, to cope with problems, and a high saturation of villages with other PWUD was reported as a major contributor to their own continued drug use. They reported a trend of drug use initiation at younger ages and increased drug use among females. Participants were interested in treatment; however, their limited knowledge about treatment options and perceived limited availability of services were barriers to treatment seeking. Easy access to drugs, primarily from Thailand and facilitated by the use of mobile phones, resulted in an expanding prevalence of drug use that underscores the need to bolster education and prevention efforts and accessibility of treatment services in Kelantan.
Fulltext Early Initiation of Amphetamine-Type Stimulants (ATS) Use Associated with Lowered Cognitive Performance among Individuals with Co-Occurring Opioid and ATS Use Disorders in Malaysia

Chooi WT, Mohd Zaharim N, Desrosiers A, Ahmad I, Yasin MAM, Syed Jaapar SZ, et al.

J Psychoactive Drugs, 2017 06 29;49(4):326-332.
PMID: 28661714 DOI: 10.1080/02791072.2017.1342152

Amphetamine-type stimulants (ATS) use is increasingly prevalent in Malaysia, including among individuals who also use opioids. We evaluated cognitive functioning profiles among individuals with co-occurring opioid and ATS dependence and their lifetime patterns of drug use. Participants (N = 50) enrolling in a clinical trial of buprenorphine/naloxone treatment with or without atomoxetine completed the Raven's Standard Progressive Matrices, Rey-Osterrieth Complex Figure Test, Digit Span, Trail Making and Symbol Digit Substitution tasks. Multidimensional scaling and a K-means cluster analyses were conducted to classify participants into lower versus higher cognitive performance groups. Subsequently, analyses of variance procedures were conducted to evaluate between group differences on drug use history and demographics. Two clusters of individuals with distinct profiles of cognitive performance were identified. The age of ATS use initiation, controlling for the overall duration of drug use, was significantly earlier in the lower than in the higher cognitive performance cluster: 20.9 (95% CI: 18.0-23.8) versus 25.2 (95% CI: 22.4-28.0, p = 0.038). While adverse effects of ATS use on cognitive functioning can be particularly pronounced with younger age, potentially related to greater vulnerability of the developing brain to stimulant and/or neurotoxic effects of these drugs, the current study findings cannot preclude lowered cognitive performance before initiation of ATS use.
Fulltext Atomoxetine for amphetamine-type stimulant dependence during buprenorphine treatment: A randomized controlled trial

Schottenfeld RS, Chawarski MC, Sofuoglu M, Chooi WT, Zaharim NM, M Yasin MA, et al.

Drug Alcohol Depend, 2018 05 01;186:130-137.
PMID: 29573648 DOI: 10.1016/j.drugalcdep.2018.01.017

BACKGROUND: Amphetamine type stimulants (ATS) use is highly prevalent and frequently co-occurs with opioid dependence in Malaysia and Asian countries. No medications have established efficacy for treating ATS use disorder. This study evaluated the safety, tolerability, and potential efficacy of atomoxetine for treating ATS use disorder.
METHODS: Participants with opioid and ATS dependence (N = 69) were enrolled in a pilot, double-blind, placebo-controlled randomized clinical trial; all received buprenorphine/naloxone and behavioral counseling and were randomized to atomoxetine 80 mg daily (n = 33) or placebo (n = 33). The effect size of the between-group difference on the primary outcome, proportion of ATS-negative urine tests, was estimated using Cohen's d for the intention-to-treat (ITT) sample and for higher adherence subsample (≥60 days of atomoxetine or placebo ingestion).
RESULTS: Participants were all male with mean (SD) age 39.4 (6.8) years. The proportion of ATS-negative urine tests was higher in atomoxetine- compared to placebo-treated participants: 0.77 (0.63-0.91) vs. 0.67 (0.53-0.81, d = 0.26) in the ITT sample and 0.90 (0.75-1.00) vs. 0.64 (0.51-0.78, d = 0.56) in the higher adherence subsample. The proportion of days abstinent from ATS increased from baseline in both groups (p 
Kratom and Pain Tolerance: A Randomized, Placebo-Controlled, Double-Blind Study

Vicknasingam B, Chooi WT, Rahim AA, Ramachandram D, Singh D, Ramanathan S, et al.

Yale J Biol Med, 2020 06;93(2):229-238.
PMID: 32607084

Background: Kratom has a long history of traditional medicine use in Southeast Asia. Consumption of kratom products has also been reported in the US and other regions of the world. Pain relief is among many self-reported kratom effects but have not been evaluated in controlled human subject research. Methods: Kratom effects on pain tolerance were assessed in a randomized, placebo-controlled, double-blind study. During a 1-day inpatient stay, participants received a randomized sequence of kratom and placebo decoctions matched for taste and appearance. Pain tolerance was measured objectively in a cold pressor task (CPT) as time (seconds) between the pain onset and the hand withdrawal from the ice bath. Health status, vital signs, objective, and subjective indicators of withdrawal symptoms, self-reported data on lifetime kratom use patterns, and assessments of blinding procedures were also evaluated. Results: Twenty-six males with the mean (SD) age 24.3 (3.4) years were enrolled. They reported the mean (SD) 6.1 (3.2) years of daily kratom consumption. Pain tolerance increased significantly 1 hour after kratom ingestion from the mean (SD) 11.2 (6.7) seconds immediately before to 24.9 (39.4) seconds 1 hour after kratom consumption (F(2,53.7)=4.33, p=0.02). Pain tolerance was unchanged after consuming placebo drinks: 15.0 (19.0) seconds immediately before and 12.0 (8.1) seconds 1 hour after consumption of placebo (F(2,52.8)=0.93, p=0.40). No discomfort or signs of withdrawal were reported or observed during 10-20 hours of kratom discontinuation. Conclusions: Kratom decoction demonstrated a substantial and statistically significant increase in pain tolerance. Further rigorous research on kratom pain-relieving properties and a safety profile is needed.

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